General Mental Health & Coping

In times of stress and uncertainty, a number of strategies can be helpful for maintaining well-being and promoting resilience. The uncertainties and specific restrictions related to the COVID-19 outbreak present particular challenges. For example, recent research has strongly supported two strategies for preventing or mitigating depressive and anxiety-related symptoms: promoting social connectedness and physical activity. In the current environment, necessary restrictions such as social distancing, self-quarantining and other measures can make this challenging. As such, we may need to be intentional about finding ways to reduce social isolation (for example: through virtual meetings, text and other messaging, or phone calls) and to engage in regular physical activity. The resources highlighted below emphasize several evidence-based self-care and coping strategies. In addition to staying connected to others and keeping up physical activity, these include maintaining pillars of well-being such as regular sleep patterns and healthy eating, as well as limiting excessive exposure to distressing media and practicing stress management techniques such as mindfulness and deep breathing. For those with symptoms of significant stress or impairing anxiety, it is helpful to recommend professional support as needed

In this guide:

• Recommendations

• Expert Strategies

• Further Reads

• Helpful Hotlines

Recommendations Resource: Managing Stress: Tips for Coping with the Stress of COVID-19 ★ Source: Harvard T.H. Chan School of Public Health Key Points:

• Stress-related reactions may include: changes in concentration/thinking/memory; feeling tense/irritable/anxious; changes in energy/appetite/sleep; social withdrawal, reduced productivity, interpersonal conflict. Some individuals may be more susceptible to stress during an outbreak, including those with prior mental health conditions.

• Coping strategies include:

1. Staying connected with family/friends/community in creative ways

2. Managing challenging emotions with acceptance, mindfulness, relaxation, soothing and/or pleasurable activities

3. Avoiding unhelpful coping strategies like substance use, rumination/constant worrying, high-risk behavior

4. Engaging in positive lifestyle behaviors such as physical activity and eating healthy, using acceptance, re-framing, and problem-solving as needed

5. Practicing sleep hygiene

Resource: Coronavirus Disease 2019 (COVID-19): Manage Anxiety & Stress Source: Centers for Disease Control & Prevention Key Points:

• Stress-related reactions to an outbreak may include: worry, changes in eating/sleeping, physical symptoms, substance use

• Coping strategies include:

1. Taking media breaks

2. Maintaining healthy behaviors

3. Engaging in relaxing activities

4. Connecting with others

• Tailored recommendations for:

• Individuals with pre-existing mental health conditions (includes hotline numbers)

• Parents and children

• Health responders

• Quarantined individuals

Resource: Mental Health and Psychosocial Considerations During COVID-19 Outbreak Source: World Health Organization Key Points:

• Tailored guidance for specific groups, including general population; healthcare workers; health facility leaders; caregivers for children; older adults and individuals with underlying health conditions; and quarantined individuals

• General recommendations:

1. Avoiding blame/stigma of others

2. Reducing excessive media exposure and consuming from reputable sources

3. Finding ways to help others and contribute to community during this time

4. Amplifying positive stories and messages

5. Recognizing service efforts of health care workers

• Recommendations for older adults and other vulnerable individuals:

1. Accessing simple and clear information

2. Planning ahead where to get practical help like food delivery, transport, medicines

3. Performing simple physical exercises at home

4. Maintaining regular routines where possible

• Quarantined individuals recommendations:

1. Staying connected to social networks virtually (e.g., phone, Internet)

2. Acknowledging needs and feelings and maintaining self-care practices during quarantine

3. Limiting excessive media exposure during this time

• Illustrated coping recommendations: View here »

Resource: Coronavirus and Mental Health: Taking Care of Ourselves During Infectious Disease Outbreaks Source: American Psychiatric Association Key Points:

• Stress-related reactions to an outbreak may include: sleep changes; decreased sense of safety; substance use; physical symptoms; fear and blame

• Coping recommendations include:

1. Staying informed via reputable sources

2. Practicing preventive hygiene behaviors

3. Limiting media exposure and correcting misinformation

4. Anticipating and addressing stress reactions via self-care strategies such as daily routines, enjoyable activities, social support, physical activity

Resource: COVID-19 Mental Health Resource Hub Source: Psych Hub Key Points:

• Collection of COVID-19 resources across different organizations (e.g., American Foundation for Suicide Prevention, National Alliance for Mental Illness, American Psychological Association), oriented at individuals, employers, and health providers

Resource: COVID-19 Behavioral Health Information Hub Source: Network of Care Massachusetts Key Points:

• Online resource hub for practical resources to support behavioral and mental health during COVID-19, ranging from mental health, suicide prevention, violence and abuse, healthcare coverage, financial and housing issues

Expert Strategies Resource: Mental Health & COVID-19 Series Source: The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health Key Points:

• Webinar series (with recordings and notes) including “How to support Patients and Caregivers”, “Workplace Mental Health”, “People in Vulnerable Situations”, etc.

Resource: COVID-19 Mental Health Forum Series Source: Harvard T.H. Chan School of Public Health Key Points:

• Weekly web forums hosted by Dr. Karestan Koenen and colleagues on evidence-based skills for managing stress related to the coronavirus outbreak and techniques for enhancing resilience.

• Previous expert-led sessions have included:

• Resilience and flexible coping

• Distress tolerance

• Grief and loss

• Self-compassion

Resource: Cognitive Behavioral Strategies to Manage Anxiety: Tools to Build Resilience ★ Source: Massachusetts General Hospital Key Points:

• Dr. Luana Marques of the Mass General Center for Anxiety & Traumatic Stress Disorders, and president of the Anxiety & Depression Association of America, delivered a Psychiatry Grand Rounds lecture on March 19, 2020

• Suggested resilience strategies included:

• “Cooling the brain” by practicing mindfulness, limiting excessive media exposure, adjusting to a new norm

• Attending to basic needs by paying attention to exercise, sleep hygiene, regular eating

• Staying connected with others

• Linked webinar series on:

1. The role of anxiety

2. Slowing down the brain

3. Charging up and staying connected

4. Exploring thoughts

Resource: Calm in the Time of Coronavirus ★ Source: Benson-Henry Mind Body Institute Key Points:

• Strategies for resilience from Drs. Darshan Mehta and Christina Luberto

• Podcast recordings from Dr. Greg Fricchione, director of the Benson-Henry Mind Body Institute at Mass General, on tools and techniques for building resilience during stressful times, including:

• How to conquer your anxieties during the COVID-19 outbreak

• Stress and anxiety in the time of COVID-19. A Harvard psychiatry professor weighs in

Resource: Managing Relationships in a Time of Social Distancing Source: Lifespan Research Foundation

• Series of recorded live streams with Dr. Robert Waldinger, director of the Harvard Study of Adult Development, to discuss the importance of meaningful connections in times of crisis, the impact of COVID-19 on relationships and creative possibilities for sustaining relationships in times of physical distancing

1. Relationships and Social Distancing

2. Managing Difficult Emotions During the Pandemic

3. How Our Life Stages Shape Our View of the Pandemic & Our Relationships

• Accompanying blog post

Resource: COVID-19 Mental Health Resources Source: McLean Hospital Key Points:

• Webinars and articles from our expert colleagues at McLean for managing mental health and practicing self-care during the coronavirus pandemic

Resource: Coronavirus Anxiety: Daily Updates Source: Dr. Jud Brewer Key Points:

• A Youtube series on coping from Dr. Jud Brewer from Brown University with tips on managing fear, uncertainty and anxiety during COVID-19. Specific topics have included:

• How to stop worrying

• How to stop compulsively checking the news

• Having trouble sleeping?

• Is stress affecting your eating habits?

• Using kindness to overcome anxiety

Further Reads Resource: 10 Mental Health Tips for Coronavirus Social Distancing Source: Mass General & Partners in Health; Dr. Giuseppe Raviola Key Points:

• Coping strategies include

1. Maintaining connections despite social distancing

2. Establishing routines

3. Exercising

4. Learning and intellectual engagement

5. Positive family time

6. Focused meditation and relaxation

7. Limiting exposure to internet/TV news

8. Maintaining a sense of humor and avoid catastrophizing

9. Positive self-talk

10. Living in the moment rather than projecting future worries

Resource: “FACE COVID” Source: Dr. Russ Harris, author of The Happiness Trap Key Points:

• Practical steps based on Acceptance & Commitment Therapy:

• F=focusing on what’s in your control

• A=acknowledging thoughts & feelings

• C=coming back into your body

• E=engaging in what you’re doing

• C=committed action

• O=opening up

• V=values

• I=identifying resources

• D=disinfecting & distancing

Resource: Coping with Coronavirus Anxiety Source: Harvard Health Blog Key Points:

• Coping strategies include:

1. Connecting with loved ones virtually

2. Relying on reputable sources of information

3. Limiting excessive information intake

4. Engaging in preventive hygiene practices

5. Engaging in relaxation via yoga, meditation or deep breathing, and practicing self-care

6. Asking: Where does anxiety show up in the body? How anxious am I? What do I fear most? What usually helps?

Resource: 7 Science-based Strategies to Cope with Coronavirus Anxiety Source: The Conversation Key Points:

• Coping strategies include:

1. Practicing tolerance of uncertainty

2. Accepting and mindfully noticing anxiety, rather than fighting it

3. Connecting to a higher purpose or cause

4. Remembering humans are resilient

5. Not overestimating threat and reducing excessive media exposure

6. Strengthening self-care and healthy lifestyle practices like sleep, exercise and relaxation techniques

7. Seeking professional help as needed

Resource: That Discomfort You're Feeling Is Grief Source: Harvard Business Review Key Points:

• David Kessler, author and founder of grief.com, is interviewed about coping with grief about the loss of safety and normalcy during this pandemic

• Recommendations include:

1. Recognizing stages of grief (denial, anger, bargaining, sadness, acceptance, meaning), which may not be linear

2. Finding balance between good and bad in our thoughts and images

3. Coming back to the present moment

4. Letting go and focusing on what can be controlled

5. Practicing compassion for others who may be expressing how they feel differently from you

6. Naming the grief and allowing feelings to happen

Helpful Hotlines

• Suicide Prevention Lifeline: 1-800-273-8255 (24/7, free & confidential support and crisis resources for people in distress)

• Crisis Text Line: Text HOME to 741741 (24/7, free & confidential support for any type of crisis)

• SAMHSA Disaster Distress Hotline: 1-800-985-5990 (24/7, free & confidential support for disaster-related distress)

• SAMHSA National Hotline: 1-800-662-HELP (4357) (24/7 treatment referral & information service for mental health and/or substance use)

• National Domestic Violence Hotline: 1-800-799-7233 (24/7, free & confidential support for resources or information around domestic violence)

• National Parent Helpline: 1-855-427-2736 (M-F, 1pm-10pm, support & parent advocacy resources)

An outbreak can affect the entire family, and special attention to the needs and stressors of children and their caregivers is warranted. View the guide Health Care Providers Resources have been developed specifically to highlight the mental health needs of health care workers during this outbreak. View the guide Specific Mental Health Conditions These resources provide a range of expert-recommended strategies for individuals dealing with or at risk for mental health conditions. View the guide For Military Families and Veterans The Home Base Program at Mass General Hospital offers free mental health services and support for veterans, service members and their families.